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PostPosted: Tue Apr 23, 2013 2:39 pm 
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Hi everyone! I'm so glad to have found this forum! I'm relatively new to the suboxone program (starting month 4) and am having some issues. I'm assuming that others have had a similar problem and so any advice would be greatly appreciated!

I began the program because of my addiction (obviously) to pain meds. I have fibromyalgia and several back/neck and foot issues that cause chronic pain. All in all, I've probably been addicted to pain meds for the better part of a decade. I've always had a pain issue and was able to get them prescribed, and then when I would run out, I would head out to the streets to continue to support my habit. It was a constant thing and life sucked. Once I got pregnant with my son, I wanted to be the best mom I could be and decided that I was doing my son and myself a great disservice by continuing to live the life (if you want to call active addiction a life) I was living. I checked myself in to rehab at 12 weeks pregnant because I simply couldn't quit, no matter how hard I tried. I did great throughout my pregnancy until I had him. Of course, giving birth is painful and from the moment I was induced, I was hooked up to the pain meds through an IV and from the moment they put that IV in my arm and I felt the meds...i knew I shouldn't have even gone there. After giving birth, I was prescribed meds for pain, and then I had an issue with my hips from having him that I could get meds for as well. After those doctors cut me off, I moved on to a different doc and found out I have several herniated disks in my neck and back. In my attempts to try and get some meds from her (my stupid addicted self didn't realize she is anti-narcotics and doesn't even prescribe them lol) she took a look at my pharmacy records and asked me, nicely, if i thought there was a chance that I had an addiction to pain medicine. I lost it, began crying, and the whole story came out. She told me about the suboxone program, and from that moment on, I have been in love.

I know that it's cheesy to say that it's a miracle drug, but for me, it has been a miracle. I finally have my life back! Even after rehab, because of my pain, I was incredibly depressed and unable to function in a normal way. Now I feel more normal than I've ever been. I've begun to have hobbies! I never would have believed I could have a happy, fulfilling life before now!

So that's my story about my road to suboxone...now I'm having a dosing issue and need some advice about where to go from here. Like I said, I have chronic pain, so my doctor is using the suboxone to treat that as well as my addiction. The first few weeks, 8 mg was perfect for me. Then, I kept having terrible pain, so my doctor moved me to 16 mg, which didn't make me feel great, but it was better than before. This last month, I made a mistake. Being the addict that I am, I thought I could be my own doctor and change my dose. I realized that if I took 24 mg, it relieved almost all of my pain (i know with chronic pain it will be impossible to ever fully relieve my pain and am content with that...I simply want to have my pain level below a 5/10) and kept me from having any cravings. I told myself that I'd only do it a few days, so that I wouldn't run out early and the doctor would never know.

Lucky for me, I found this forum, and read the advice from everyone who has said that in order to beat our addictive tendencies, we must be first and foremost HONEST with our doctors. So today, when I went in, I explained the situation to my doctor. I admitted my mistake and told her my reasoning. I told her that if she wanted to monitor me more closely, I understood (she said she thought that was a good idea) and that I believed my dose she be raised. She disagreed, but not because she didn't want to. She said that if she put me up to 24 mg, the DEA, the pharmacists and everyone would "have an eye on me" and that the maximum dose she could prescribe was 16 mg.

Now, I know from reading on here that this is simply not true. I also asked the pharmacist if this was true, and he reassured me that many people who get suboxone from his pharmacy are on 24 mg a day. Does anyone know why my doctor would say these things and why she wouldn't feel like my dose should be raised if I'm still having severe pain issues and cravings? I know that as an addict, sometimes our credibility is questioned, but I have never failed a urinalysis or gave her any indication that I couldn't be trusted...if anything, I've been extremely honest with her, as hard as that is. My first instinct was to begin looking for a different doctor. But I realize that doing that would be addict behavior, wouldn't it? I know that there is a ceiling and I can't take more than 32 mg a day. I don't ever want that high of a dose. I have no interest in catching a buzz or in continuing to raise my dose, I simply know that 24 mg. a day worked really well for me, took away all my cravings and most of my pain.

Does anyone have any advice about this? Should I look for a different doctor or tell her what I've learned from the pharmacist? I mentioned that I had read here that it was a perfectly acceptable dose, but her response was that you can't believe everything you read online. lol I'm at a loss. I don't want to find another doctor because I love mine, but I completely disagree with her about this, and am worried that if i stay on too low of a dose, I'm going to continue to self treat, or go back to my old ways and try to find some through the streets. In fact, I know I will. Is this my addict self? Am I wrong? I feel as though if there is a significant amount of cravings involved, I'm at the wrong dose. What do you all think?

Thanks in advance for reading my story...even though it is more of a novel. lol

Hope you are all doing well and are happy and blessed in your sobriety! :)


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PostPosted: Tue Apr 23, 2013 4:11 pm 
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As far as not raising your dose your doctor could just be upset because you raised your dose without first consulting her, and maybe she finds that to be addict behavior. If I may ask how many times a day are you dosing? I know that for chronic pain a lot of people say that you need to dose several times a day. So if you are on 16 mg a day maybe try and cut them in half and take 4mgs 4 times a day. If that doesn't work maybe you do need to be on a higher dose. Maybe your doctor was just testing you to see if you really needed it or if you were just trying to get more out of her.

I hope this helps!
Erica

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"always be at war with your vices, and at peace with your neighbors."


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PostPosted: Tue Apr 23, 2013 6:04 pm 
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Thank you for your response! I didn't think of her thinking I was just trying to get more from her. I guess there are people who an use the system so maybe that's it. Hopefully that's it. I have really bad pain in the morning so I usually take a full strip right after breakfast. Then I take my second around lunch. I used to split them up but it seemed I would just take one right after the other, but now that she won't increase it I have no options so I will give it a try again. I go back again in two weeks ao perhaps if I still feel this way something can be done. Thanks again! :)


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PostPosted: Wed Apr 24, 2013 12:15 am 
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As long as you're in pain I would tell her every time I saw her that I was still in pain and it was affecting my quality of life. Have you ever thought of maybe taking something along with the sub like maybe tramadol? I would just say something like "I know you don't want to increase my dose, so is there something else you can give me to take along with the suboxone?". Then maybe if she won't increase your dose she will give you something to go along with it and maybe that will help your pain.

Good luck,
Erica

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PostPosted: Wed Apr 24, 2013 1:08 pm 
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Hi there Forever...

I have tried to respond to your post twice before this and my computer keeps backing me up and losing my message after I have it all typed out. Grrrrr.....I hate it when that happens! I had two long detailed posts for you but after writing it out twice now and losing it I am going to try to keep this one short and simple. :D

I understand that you are a chronic pain patient. That really sucks, having constant pain while battling this particular addiction makes it really hard to reach recovery. My pain issues have been a trigger for me throughout my treatment. I can't tell you how many times I have run out of medicine early because I was taking more than prescribed trying to make myself feel better. I was like you when I started, I would have taken as much suboxone as my doctor was willing to prescribe. Lucky for me I have a doctor who understands how this medicine works a little better than most and is VERY careful not to prescribe extremely high doses. I know there is alot of conflicting information out there about suboxone, and there are alot of doctors who do prescribe doses as high as 36mg per day. But I just don't agree that this is a good thing. In my experience I felt basically the same whether I took my prescribed 8mg dose or doubled up to 16mg per day. My addict self wanted to believe that I needed more, and I continued to shoot myself in the foot month after month trying to make myself feel better. Like you I never received complete relief from cravings no matter what dose I took. I know alot of people say it does that for them, but for me it didn't. It lessened the cravings ALOT, it made them bearable, but they never went away completely. I know you said you were aware of the ceiling effect of buprenorphine but do you know at what dose that ceiling is reached? According to Dr. Junig it is reached somewhere between 8-12 mg. Now here is where I start to hesitate in explaining this to you...I don't want to give you any wrong information. I am only relaying information that I have gathered mostly from this site and giving you my own impressions of my treatment and experiences with suboxone. It is my understanding that anything taken after the ceiling has been reached is simply being wasted. Your body is not using that extra medicine. I like to think about it like this. Picture an empty 5 gallon bucket, we will pretend this bucket is your opiate receptors. We place the empty bucket outside in the rain (the rain represents the buprenorphine in suboxone.) The bucket will only hold 5 gallons of water, (that is the ceiling level) it will catch the rain as long as it falls until it is completely full. Once the bucket is full it might keep raining, but the water isn't going to be caught in the bucket, it's going to run out on the ground because the bucket can't hold any more water. This is how the ceiling effect of suboxone works. You might continue to take doses in excess of the ceiling level, but they aren't really having any effect on your system. The extra just continues to "run out" of your opiate receptors because they are already full. Any relief you feel from the extra dose is, to my understanding, purely psychological. Now please understand, I'm not saying you are wrong for wanting to take more or have a higher dose. I felt exactly the same as you when I first started taking subs. If my doctor prescribed me 36 mgs I would have thought I needed 48. That is how this addiction works. What I'm trying to tell you is that now that I am past the initial stages of suboxone treatment and well into my tapering I am EXTREMELY happy that my doctor was strict and kept me at a fairly low dose. Large doses of suboxone may not help your cravings or pain but it will drive your tolerance through the roof and make it HELL if you decide to taper and quit later on.

Please check out the sticky post right above yours in the index titled "The Ceiling". This is a great thread and all this information is covered there. I have to agree with something that squeeky said to you. If your pain is not controlled with the suboxone maybe you can check into tramadol. This is the only pain medicine that is recommended to be used in conjunction with suboxone treatment. It's fairly good at controlling pain, but be careful with it. Some people don't have problems with it but it can be addicting. However if it was me I would much rather add something like this than take such a large dose of suboxone.

You also asked why your doctor would tell you that she couldn't prescribe more than 16mgs per day. I'm like you, it sounds like she may be lying about parts of her explanation, maybe trying to placate you by making it look like it is out of her hands. However some of it does ring true. I was recently told by my psychiatrist that a very large number of doctors are currently under investigation for overprescribing suboxone to patients. This might be what she meant when she said the DEA would be on her case if she prescribed more than 16mgs. There's really no way to tell unless you confront her...and to me it wouldn't be worth it. If she doesn't feel comfortable prescribing more than 16 theres probably not much you can say that would change her mind.

I hope you understand that I'm only concerned about you and not trying to make it seem as if you are doing anything wrong at all by wanting to have your pain under control. I just worry about patients being given such large doses at the beginning of their treatment only to realize later on that it was a mistake. Alot of patients just don't have the information they need to be able to make these decisions on their own. We trust our doctors to know what they are doing and unfortunately alot of them just don't have any idea.

Whatever you decide, I wish you the best of luck and hope you will continue posting and let us know how you are doing.

-Q :D


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PostPosted: Wed Apr 24, 2013 3:01 pm 
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Thank you both so much for your help! I appreciate what you have to say. Unfortunately, I've gotten addicted to tramadol in the past, so I'm not sure if that's the best route, plus it's now a controlled substance, which my doctor refuses to prescribe. Perhaps an anti depressant geared towards pain like cymbalta or something might help, since I have been diagnosed with depression in the past. Either way, ill bring it up at my next visit. Chronic pain is a beast, and when coupled with addiction, it's incredibly frustrating and can feel hopeless. But I know there is hope and we can get it figured out one way or another. Thanks again for your responses, they give me hope that we can find something that will work. :) have a great day!


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PostPosted: Wed Apr 24, 2013 3:44 pm 
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Since you are in chronic pain, have you thought about switching from Suboxone to Methadone. Methadone seems to help with pain and treat addiction. Just a thought. I know that there are many Suboxone Clinics that dispense both meds.


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PostPosted: Wed Apr 24, 2013 10:13 pm 
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To be honest, raudy, I've always been somewhat scared of methadone since its a pain killer. With my history of addiction, I doubt I could be given a script without over indulging myself :/ thanks for the thought though :)


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